Your Good Health: Woman, 61, has low sex drive

Dear Dr. Roach: I am a 61-year-old woman who has lost most of her sexual drive. My OB/GYN has suggested bioidentical hormone replacement therapy. My online research did not do much to enlighten me. The cost is pretty high. What can you tell me about this?
    
T.W.

There is no evidence that bioidentical hormone preparations are safer or more effective than those that can be prescribed and that are Food and Drug Administration-approved. The FDA is taking action against pharmacies that make false and misleading claims about medications, which usually come from compounding pharmacies.

All hormone replacement drugs, whether plant-derived, synthesized or from animal products, may increase the risk of heart attack, blood clots and breast cancer. In many cases, the drugs used are molecularly identical, whether it comes from a compounding pharmacy or from traditional pharmaceutical companies. Compounding pharmacies are not subject to FDA approval, and may have inconsistencies in amount or absorption of the hormones.

Low sex drive is a common problem in women. Studies have shown that estrogen and progesterone are not effective. Testosterone, the hormone associated with men, also is found in women and has been found to be effective for some women with low sexual desire, although there are risks with testosterone in women.

A new drug, flibanserin, has been approved for use in women with distress due to low sexual desire, but it is only modestly effective.

Nonpharmacological treatments such as couples and sexual therapy, lifestyle changes designed to reduce stress and promote good relationships and regular exercise such as aerobic exercise or yoga may have better effects on women’s sexual desire than medication.

Dear Dr. Roach: I would like your opinion on a mild problem I have. Beginning at breakfast, my nose begins to run almost constantly. The situation is worse if I am drinking a hot liquid, like coffee. After breakfast, the running stops, and all is then normal.  

S.G.

This is a classic example of gustatory rhinitis, a type of nonallergic rhinitis (“rhino” is the Greek word for “nose”; “itis” is for “inflammation”). The vagus nerve, which provides the nerve supply to many organs, is responsible for this confusion, as is the case with some other abnormal reflexes.   

I have found that ipratropium nasal spray is effective for most people with gustatory rhinitis. It’s a prescription medicine, so ask your doctor about it.

Dear Dr. Roach: When my daughter had cancer, her oncology doctor recommended swishing buttermilk in her mouth for thrush. It worked. I am not sure whether it cured the thrush or just brought her relief, but at least two or three times a day, she would ask for buttermilk.  

V.F.

I have read many accounts of buttermilk helping treat yeast infections of the mouth (thrush). I found one paper from 2009 showing that cultured milk products have yeast-killing properties. However, standard treatment with nystatin, fluconazole or similar agents is very effective, with few side-effects.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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